Amy: Part of our motivation in writing this blog is to share some of the unconventional wisdom of family therapy, with the idea that our knowledge and experience can help our readers. We know our family systems perspective is now on the margins of contemporary culture. Over the last twenty years or so, with the increased power of the drug companies and the medicalized view of mental health, the relationship dimension in understanding human suffering has largely gotten lost. Conventional psychotherapy/psychiatry regards problems of ADHD, depression, anxiety, “oppositional-defiant” diagnoses in kids, for example, as individual “disorders” to be treated with medications and/or an individual therapy like CBT.
But my co-blogger David Keith and I tell a different story. Trained in the theory and practice of family systems, we have learned how to understand and observe family interpersonal patterns. For us, common psychiatric “disorders” are part of relational patterns, usually embedded in the dynamics of the family. You just have to know how to look. Perhaps the most counter-intuitive assumption in family therapy is the idea that kids with behavior problems are often trying to help repair the wounds in the family. Sounds crazy, right?
Here’s a case that shows what I mean…
Case: For several years I was involved in doing some teaching with child therapists who wanted to learn more about the family therapy model. As part of my work, I would often do “live” consultations with a child and his/her family. This particular day I showed up at the Child Guidance Clinic to do a live family therapy consultation with a notorious kid and his family. The kid, Eric, an nine-year old boy, was supposedly so incorrigible that he had to be placed in Residential Treatment for a couple of weeks to give his parents a break.
As I seated myself for the interview, I heard the therapist from the Treatment Center struggling with this child, trying to get him to go into the interview room. The parents were already seated. Soon I heard this high-pitched voice, a baby voice really, saying (trying to sound menacing): “Who’s this whore from New York City? Why should I go to see her?” I burst out laughing. Here is this little kid, practicing throwing his weight around, doing his best to be a tough guy.
I wiped the smile off my face, and asked the parents what they wanted to do. After some equivocation on their part, I suggested that the parents try to get Eric to come in. (I thought this would give me a chance to get a glimpse of the family operating system.) First Dad went in, then Mother. I could hear some ineffective yelling, and both parents returned to the interview room, defeated. I suggested we begin the interview. (I had in my mind that I didn’t want the kid to hold the parents hostage. I guessed that this happened too much already.)
Here’s the brief version: For the next half hour, I sat with the parents and began to understand some of the tensions in this family. They began by talking about the “impossible” behavior of their only child, who clearly learned how to push his parents’ buttons. He cursed, he threw things, refused to obey, though he was relatively well-mannered at school. As I inquired further, exploring their patterns of relationship, Mother began complaining that Father worked all the time; his rather demanding job in health care administration meant long days and a long commute. And she complained bitterly about her own mother’s overly intrusive behavior in the family. Mother’s mother apparently didn’t like the father, and she colluded with her grandson to raise hell against the father. Mother described how own mother had always been very critical and judgemental. I wondered to myself if Mother was trying to divorce her own mother and marry her husband. Mother looked like a lonely person to me. Both parents, though quite thoughtful and well-meaning people, looked extremely lonely and isolated. I commented on this.
We were in the heat of conversation when their little son walked in. I pulled up a chair for Eric and he sat quietly by my side, listening. We all ignored him, not out of design, but there was a bit of a “spell” cast in the session; the parents were talking about matters that were quite painful for them, perhaps for the first time. Some of the fissures in their relationship were being exposed, and, to their credit, they didn’t want to lose the moment. I think they felt rather relieved to be able to unburden themselves to a non-judgemental professional, someone with an expertise in families.
As the session continued, I invited Eric to comment on what he heard. He seemed fascinated by the discussion in the room. He commented quietly, adding his own take on his family troubles. Eric sat by my side comfortably, like my co-therapist. Not surprisingly, from my experience, he knew a lot about his parents’ pain. He talked about how his Grandma “hated” his father, and how she bribed him “to be on her side”, as he saw it. He sounded like he felt a lot of pressure from “Granny”. He talked about how his father was never home, and how he worried about his Mom, who was often left alone with only Grandma as her companion.
His worry about the difficult triangular relationship between his parents and Grandma was clearly not far from his mind. I believe that in his own little way, he was trying to help his family with their suffering. I wondered if he was trying to re-engage his Dad, maybe to help rescue his Mother. His “impossible” behavior brought Dad home, at least temporarily. I think he was also perhaps trying to show the Dad how to stand up for himself, not to avoid conflict–something he needed to learn to do with his mother-in-law, and possibly with his wife. Little Eric was the self-appointed Family Therapist. I made an indirect comment to this effect, and he didn’t disagree. The parents listened , and took it in.
This was not the kid I was led to expect. I don’t think this was the kid who usually showed up.
The session soon drew to a close. I would not be seeing the family again, as I was the consultant on the case. But the therapist for the child and family was observing the session on the other side of the one-way mirror and I let the parents know that I would remain as a consultant to their therapist. I told the parents how much I’d been impressed by their courage, and wished them good luck. The room had a stillness to it.
As we walked out, little Eric came up and put his arms around my waist and hugged me. At first I was caught off-guard. Then I found this very touching. He seemed like a little nine-year old boy, exhausted from trying to help his folks, and relieved to be off-duty. This job was way beyond his pay-grade.
In our post-interview follow-up, the therapists were stunned to see Eric like this–a softy, a little boy. I told them about the hug. I said that I thought Eric was showing appreciation for me and my willingness to address the suffering of his folks. His parents, through the subtleties of conversation, went from seeing Eric as “the problem” to understanding their child’s desperation at seeing his parents so stuck, so unhappy. This boy was very attuned to the undercurrents of their unresolved family tensions. This little guy, a former Terror, re-branded as the Family Doctor.
Case Follow-Up: Of course, nothing is simple. The child was released from Residential Treatment and the family began seeing one the Clinic therapists. The therapy was rocky, with Eric continuing to act crazy from time to time, but with less intensity. At my last session with the therapist, the family continued to slowly address some of their underlying tensions, gradually easing the pressure on the child. The family was slowly getting better.